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Physical and Mental Health in Patients and Spouses After Intensive Care of Severe Sepsis: A Dyadic Perspective on Long-Term Sequelae Testing the Actor–Partner Interdependence Model*

Rosendahl, Jenny PhD1,5; Brunkhorst, Frank M. MD2,4,5; Jaenichen, Doreen MD1–3; Strauss, Bernhard PhD1

doi: 10.1097/CCM.0b013e31826766b0
Clinical Investigations

Objective: To examine the physical and mental long-term consequences of intensive care treatment for severe sepsis in patients and their spouses under consideration of a dyadic perspective using the Actor–Partner Interdependence Model.

Design: Prospective study.

Setting: Patients and spouses who had requested advice from the German Sepsis Aid’s National Helpline were invited to participate.

Subjects: We included 55 patients who survived severe sepsis and their spouses an average of 55 months after ICU discharge.

Measurements and Main Results: The Hospital Anxiety and Depression Scale, the Short Form-12 Health Survey, the Posttraumatic Stress Scale-10, and the Giessen Subjective Complaints List-24 were used. The Actor–Partner Interdependence Model was tested using multilevel modeling with the actor effect representing the impact of a person’s posttraumatic stress symptoms on his or her own mental health-related quality of life and the partner effect characterized by the impact of a person’s posttraumatic stress symptoms on his or her partner’s mental health-related quality of life. A significant proportion of patients and spouses (26%–42%) showed clinically relevant scores of anxiety and depression; approximately two thirds of both, patients and spouses, reported posttraumatic stress symptoms defined as clinically relevant. Compared with normative samples, patients reported greater anxiety, poorer mental and physical health-related quality of life, and greater exhaustion; spouses had an impaired mental health-related quality of life and increased anxiety. Testing the Actor–Partner Interdependence Model revealed that posttraumatic stress symptoms were related to patients’ (β = −0.71, 95% confidence interval −0.88 to −0.54) and spouses’ (β = −0.62, 95% confidence interval −0.79 to −0.46) own mental health-related quality of life. Posttraumatic stress symptoms further influenced the mental health-related quality of life of the respective other (β = −0.18, 95% confidence interval −0.35 to −0.003 for patients; β = −0.15, 95% confidence interval −0.32 to 0.02 for spouses).

Conclusions: Interventions to treat posttraumatic stress symptoms after critical illness to improve mental health-related quality of life should not only include patients, but also consider spouses.

1 Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Friedrich-Schiller University, Jena, Germany.

2 Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Friedrich-Schiller University, Jena, Germany,

3 Department of Internal Medicine II, Jena University Hospital, Friedrich-Schiller University, Jena, Germany.

4 Paul-Martini Research Group for Clinical Sepsis Research, Jena University Hospital, Friedrich-Schiller University, Jena, Germany.,

5 Center for Sepsis Control and Care, Jena University Hospital, Friedrich-Schiller University, Jena, Germany.

*See also p. 339.

The work was performed in Jena University Hospital, Friedrich-Schiller University, Jena, Germany.

Dr. Brunkhorst is head of the Paul-Martini Sepsis Research Group, funded by the Thuringian Ministry of Education, Science and Culture (ProExcellence; PE 108-2), the Thuringian Foundation for Technology, Innovation and Research (STIFT), and the German Sepsis Society (GSS). The authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: jenny.rosendahl@med.uni-jena.de

© 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins